Association of metabolic dysfunction-associated fatty liver disease with microvascular complications in adults with prediabetes

This study aimed to investigate the associations of metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD) with diabetic microvascular complications (DMC) in adults with prediabetes.

A total of 50,123 adults with prediabetes from the UK Biobank were included. Participants were categorized into MAFLD/non-MAFLD groups and MASLD/non-MASLD groups. The severity of MAFLD/MASLD was assessed by noninvasive fibrosis scores and metabolic dysfunctions. DMC included diabetic retinopathy, neuropathy, and nephropathy. Cox proportional hazard regression models were used to assess the associations. Over a median follow-up of 13.4 years, 4327 participants developed DMC, including 394 cases of diabetic retinopathy, 440 of neuropathy, and 3682 of nephropathy. After fully adjustment for confounders, both MAFLD and MASLD were significantly associated with an increased risk of overall DMC (HR1.35[95 % CI:1.24, 1.46]), p < 0.001 and HR1.37[95 % CI:1.26, 1.49], p < 0.001, respectively) and its subtypes compared to non-MAFLD/non-MASLD participants. Furthermore, the risk of overall DMC increased with the elevated liver fibrosis scores and metabolic dysfunction numbers. In addition, The association between MAFLD/MASLD and risk of DMC remained significant in sensitivity analyses.

In the UK Biobank cohort, both MAFLD and MASLD were independently associated with an increased risk of DMC and its subtypes in individuals with prediabetes. These findings highlight the importance of proactively monitoring and preventing MAFLD/MASLD for adults with prediabetes.